Civil Commitment Laws Research Articles

The impact of civil commitment laws for substance use disorder on opioid overdose deaths.

Our study analyzed the impact of civil commitment (CC) laws for substance use disorder (SUD) on opioid overdose death rates (OODR) in the U.S. from 2010-21. We used a retrospective study design using the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) dataset to analyze overdose death rates from any opioid during 2010-21 using ICD-10 codes. We used t-tests and two-way ANOVA to compare the OODR between the U.S. states with the law as compared to those without by using GraphPad Prism 10.0. We found no significant difference in the annual mean age-adjusted OODR from 2010-21 between U.S. states with and without CC SUD laws. During the pre-COVID era (2010-19), the presence or absence of CC SUD law had no difference in age-adjusted OODR. However, in the post-COVID era (2020-21), there was a significant increase in OODR in states with a CC SUD law compared to states without the law (p = 0.032). We also found that OODR increased at a faster rate post-COVID among both the states with CC SUD laws (p < 0.001) and the states without the law (p = 0.019). We found higher age-adjusted OODR in states with a CC SUD law which could be due to the laws being enacted in response to the opioid crisis or physicians' opposition to or unawareness of the law's existence leading to underutilization. Recent enactment of CC SUD law(s), a lack of a central database for recording relapse rates, and disparities in opioid overdose rate reductions uncovers multiple variables potentially influencing OODR. Thus, further investigation is needed to analyze the factors influencing OODRs and long-term effects of the CC SUD laws.

Potential Effects of Dobbs v. Jackson Women's Health on Civil Commitment Law.

Since the publication of the U.S. Supreme Court's decision in Dobbs v Jackson Women's Health in June of 2022, much attention has been paid to the direct effects of that decision on reproductive health care for pregnant or potentially pregnant individuals; and to the potential effects of the Court's approach in Dobbs to other established precedent related to privacy and autonomy, such as rights to contraception and marriage equality.This Article will explore another potential negative consequence of Dobbs; its potential effect on the constitutional parameters of the law of civil commitment and involuntary medication of the mentally ill.The foundational Supreme Court case establishing the parameters of the State's right to involuntarily commit an individual to a mental institution was decided only two years after Roe v. Wade.In 1975, the Supreme Court in O'Connor v Donaldson held that an individual has a liberty interest in "prefer[ring] one's home to the comforts of an institution," and that a State could not, "without more," confine a non-dangerous individual.The two-prong test of requiring a showing of both mental illness and dangerousness to one's self or to others has remained the cornerstone of civil commitment law ever since.The language and analysis of O'Connor is similar to that of Roe, the abortion rights case overturned by Dobbs.In particular, the grounding of the right to avoid civil commitment in the individual liberty and privacy interests are common themes in the two cases.The current Court, in its decision in Dobbs, has cast substantial doubt on the continued vitality of that analysis; and one can easily imagine a reconceptualization of O'Connor along the lines of Dobbs that substantially alters the requirements for civil commitment. In particular, the reliance in Dobbs and other recent Supreme Court opinions on historical precedent as a linchpin of originalist analysis could lead the Court to search for justifications in colonial or 19th-century mental health practices, time periods which predate modern psychiatric science.This Article will explore the parallels in approach between Roe and O'Connor, and will suggest ways in which the post-Dobbs Supreme Court majority might disrupt the civil commitment status quo, including potential expansion of civil commitment or other detention of pregnant individuals for the protection of the fetus; and possible relaxation of the dangerousness requirement for civil commitment articulated in O'Connor.

Civil Commitment Law with a Focus on Hospitalized Patients History and Practice in Kansas: Part I and Part II.

Civil Commitment Law with a Focus on Hospitalized Patients History and Practice in Kansas: Part I and Part II.

Cops, Clinicians, or Both? Collaborative Approaches to Responding to Behavioral Health Emergencies.

How a community responds to behavioral health emergencies is both a public health issue and social justice issue. Individuals experiencing a behavioral health crisis often receive inadequate care in emergency departments (EDs), boarding for hours or days while waiting for treatment. Such crises also account for a quarter of police shootings and >2 million jail bookings per year. Racism and implicit bias magnify these problems for people of color. Growing support for reform provides an unprecedented opportunity for meaningful change, but solutions to this complex issue will require comprehensive systemic approaches. As communities grapple with behavioral health emergencies, the question is not just whether law enforcement should respond to behavioral health emergencies but how to reduce unnecessary law enforcement contact and, if law enforcement is responding, when, how, and with what support. This policy article reviews best practices for law enforcement crisis responses, outlines the components of a comprehensive continuum-of-crisis care model that provides alternatives to law enforcement involvement and ED use, and offers strategies for collaboration and alignment between law enforcement and clinicians toward common goals. Finally, policy considerations regarding stakeholder engagement, financing, data management, legal statutes, and health equity are presented to assist communities interested in taking steps to build these needed solutions.

The Right to Choose

The Right to Choose

The Treatment Advocacy Center (TAC) has announced Lisa Dailey as acting executive director

The Treatment Advocacy Center (TAC) has announced Lisa Dailey as acting executive director, effective Jan. 12. Dailey was the director of advocacy for TAC. Former TAC Executive Director John Snook on Jan. 11 assumed the position of director of government relations and strategic initiatives at the National Association for Behavioral Healthcare. “During his tenure, John presided over the publication of 15 major research reports, guided the passage of the bipartisan mental health reforms of the 21st Century Cures Act, secured more than $70 million in federal funding for assisted outpatient treatment programs around the United States, and oversaw the passage of 44 new laws designed to improve access to treatment for people with severe mental illness,” said Dr. Michael Knable, chair of the Treatment Advocacy Center board of directors. “We are grateful for his impactful leadership and are excited to continue partnering with him in his new role.” In her role as TAC's director of advocacy for the past two years, Dailey expanded the adoption of Laura's Law to nine additional counties, was the lead author on two iterations of “Grading the States,” the first comprehensive evaluation of civil commitment laws by state published since 2014, and successfully lobbied for the improvement of civil commitment criteria and other serious mental illness legislation in nine states.

Incompetent to Stand Trial, Not Restorable, and Dangerous.

This article focuses on the preferred disposition for an individual charged with a serious crime against another person, adjudicated incompetent to stand trial and not restorable to competence, whose original criminal charges are dismissed without prejudice, and who is regarded by the state as dangerous to the general public. Three current models used today in California, Oregon, and Ohio are described. All three rely on modifications of various aspects of civil commitment law. We then propose a fourth model based on a modified version of the 1989 American Bar Association (ABA) Criminal Justice Mental Health Standards, in which individuals who are found incompetent to stand trial and not restorable to competence and are considered dangerous would be committed under the same special procedures governing the management and treatment of insanity acquittees.

The "Uncanny Valley" and the Verisimilitude of Sexual Offenders--Part I

This Article is the first in a series of three articles in which I explain the cycle of misperception of sexual offenders that has encouraged the unconstitutional application of sexual offender laws, including civil commitment laws, in a false effort to quell public fear, protect children, and reduce sexual victimization. In this first Article of the series, I propose that this cycle of misperception and the resistance to the release of civilly committed sexual offenders may be, in part, the product of a novel phenomenon known as the “uncanny valley” effect.

Ethics Considerations of Involuntary Outpatient Treatment

Ethics Considerations of Involuntary Outpatient Treatment

Throwing Away the Key: The Ethics of Risk Assessment for Preventive Detention Schemes

Preventive detention schemes that aim to protect the community from certain ‘dangerous’ individuals have long existed. While risk assessment is now pervasive in the management and treatment of many individuals, it raises particular issues when a person's liberty is at stake on the basis of what that person might do. This R.G. Myers Memorial Lecture addresses the ethical issues raised by mental health practitioners providing risk assessments for legislative schemes that involve the deprivation of liberty. It will focus in particular on Australian post-sentence preventive detention schemes for sex offenders that have been held by the United Nations Human Rights Committee to breach fundamental human rights. However, the ethical issues discussed also have repercussions for civil commitment laws that enable the detention of those with severe mental or intellectual impairments.

Sociology of Law: How It Can Be Implemented to Control the Violence and Crime among Youth in Pakistan

Sociology of law controls the behavior, attitudes, and the actions of the individuals to balance their social situation. Each society is controlled by the agents of social control like family, neighborhood, religion, education, law, administration, force, and public opinion.In Pakistan, money, land, sexual assault, illiteracy, honor killing, old enmity, and drug are the main factors causing juvenile delinquency. Pakistan has more potential to control crime and violence by the implementation of informal and formal social control.In this modern world media which is considered as the fourth pillar of the state, the big tool of controlling the agents of informal social control like family, religion, public opinion etc.Formal social control agents is carried out by state, such as police officers, judges, school administrative law, control of deviance through civil commitment and criminal law, employers, military officers, and non-political control agencies, like NGOs.Pakistani families are mostly illiterate, they don’t know what should do and what we should not do. They don’t know what socialization is? Mostly criminals are the product of poverty, wrong socialization of family and the negative environmental circumstances.To control poverty, Human resource management should make effective and fair and the distribution of wealth should be equal, if we want equality we will have to follow the Islamic principles of economics.

Accuracy of Sexually Violent Person Assessments of Juveniles Adjudicated for Sexual Offenses

This study reviewed the records of 198 juveniles who were committed to secured custody after being adjudicated delinquent for a sexually violent offense that qualified them for possible commitment under a Sexually Violent Person's (SVP) civil commitment law. For an individual to be committed, the statute requires that the individual have a qualifying mental disorder and is "likely," to commit a future act of sexual violence. Each youth was screened by at least two expert examiners in a two-step process. Fifty-four of the youth were found to meet the commitment criteria in an initial examination and were subject to an SVP petition. The remaining 144 were screened out. Subsequent criminal charges were collected over a 4.97-year mean follow-up. The results showed that the prevalence rates for general sexual offending and felony sexual offending did not differ between youth who were screened out and those who were subject to a petition. Among petitioned youth, 11.76% were charged with a new sexual offense including 9.80% who were charged with a felony sexual assault. By comparison, 17.36% of the youth that were screened out were charged with a sexual offense including 13.19% who were charged with a felony sexual assault, a nonsignificant difference.

M. v. Germany: The European Court of Human Rights Takes a Critical Look at Preventive Detention

For the past two decades American courts have grappled with the constitutionality of a new generation of civil commitment laws that have dramatically expanded the use of preventive detention. Similar laws and resulting challenges have arisen in Europe, and a recent opinion by the European Court of Human Rights signals a new development in European law governing the scope of preventive detention — a new development that both mirrors and contradicts early developments in United States civil commitment jurisprudence.To provide context for American readers, this article first looks briefly at the legal landscape for preventive detention in the United States and then examines the European Court’s decision in M. v. Germany. The article continues with a comparative analysis of the American and European decisions, noting similar problems and contrasting divergent approaches as both Europe and the United States struggle to establish appropriate boundaries for the implementation of preventive detention and concludes with a brief a discussion of the recent developments in Germany since the European Court of Human Rights decided M. v. Germany.

Dangerously misunderstood: Representative jurors' reactions to expert testimony on future dangerousness in a sexually violent predator trial.

Past research examining the effects of psychological expert testimony concerning future dangerousness in sexual violent predator commitment trials has produced equivocal results on whether mock jurors are more influenced by intuitive clinical expert testimony than empirically based actuarial testimony. This study advances this line of research by examining these effects using a more ecologically valid sample of 156 venire jurors who watched a simulated, videotaped SVP trial based on a case transcript. As predicted, jurors were more influenced by the less scientific, clinical expert testimony. The data provided only limited support for a theoretical explanation based on Cognitive-Experiential Self-Theory (CEST). The policy im- plications of these results are discussed. In the United States legal system, predictions of an individual's future likelihood of reoffense or violence have a long history. These predictions are employed in many legal determinations that have significant liberty implications for the individuals involved, from bail decisions to capital sentencing. In the last 20 years, a significant minority of states have adopted Sexually Violent Predator or Person laws (hereinafter SVP laws). These modified civil commitment laws allow for postincarceration civil confinement of sexual offenders who are found likely to commit future acts of sexual violence. In these legal adjudications, mental health experts proffer expert testimony on whether or not a specific individual poses a future danger. Yet, almost since the inception of dangerous- ness-based legal standards, the expertise of mental health professionals on these matters has been questioned (e.g., Krauss & Sales, 2001; LaFond, 2005; see Slobogin, 2006 for a detailed discussion of these issues). Historically, courts have been largely deaf to the cries of critics in these important legal decisions. Beginning with the landmark U.S. Supreme Court decision inBare-

Civil commitment law, mental health services, and US homicide rates

The study considers whether involuntary civil comment (ICC) statute provisions are associated with homicide rates. Do statutes based solely upon dangerousness criteria versus broader ICC-criteria-i.e. "need for treatment," "protection of health and safety," and family protection-have differential associations related to their goal of reducing the frequency of homicide? State-level data were obtained from online data bases and key-informant surveys. Ordinary-least-squares and Poisson regression were used to evaluate the association between statute characteristics, mental health system characteristics, and 2004 Homicide Rates after controlling for firearm-control-law restrictiveness and social-economic-demographic-geographic-and-political indicators historically related to homicide rate variation. Poisson and OLS models, respectively, were significant: likelihood ratio χ(2) = 108.47, df = 10; p < 0.000 and Adj. R (2) = 0.72; df = 10, 25; F = 10.21; p < 0.000. Poisson results indicate that social-economic-demographic-geographic-and-political-indicators had the strongest association with state homicide rates (p < 0.000). Lower rates were associated with: broader ICC-criteria (p ≤ 0.01), fewer inpatient-bed access problems (p ≤ 0.03), and better mental health system ratings (p ≤ 0.04). OLS results indicate that social-economic-demographic-geographic-and-political indicators accounted for 25% of homicide rate variation. Broader ICC-criteria were associated with 1.42 less homicides per 100,000. Less access to psychiatric inpatient-beds and more poorly rated mental health systems were associated with increases in the homicide rates of 1.08 and 0.26 per 100,000, respectively. While social-economic-demographic-geographic-and-political indicators show the strongest association with homicide rate variation, the results show the importance and potentially preventive utility of broader ICC criteria, increased psychiatric inpatient-bed access, and better performing mental health systems as factors contributing to homicide rate variation.

Association of Involuntary Psychiatric Examination With Probability of Arrest of People With Serious Mental Illness

This study examined the association between the occurrence of an involuntary psychiatric examination under Florida civil commitment law and the probability of arrest during the next quarter. County criminal justice records and several statewide and local health and social service data sets were used to identify inmates with a serious mental illness who spent at least one day in the Pinellas County jail between July 1, 2003, and June 30, 2004. These same data sets were combined with statewide arrest and prison records to identify the criminal justice and health and social services histories of these individuals from July 1, 2002, to June 10, 2006, with the four-year period divided into 16 periods of 90 days. The main analysis used individual fixed-effects models to examine the relationship between involuntary examinations and subsequent probability of arrest. There were 3,728 inmates with serious mental illness in the sample, with 40% (N = 1,485) having at least one involuntary examination during the four-year period. Individuals who experienced an involuntary examination during the four years were arrested in 34% (N = 1,038) of the quarters after an examination and in 27% (N = 3,786) of the quarters not preceded by an involuntary examination. Individual fixed-effects models found a significant positive relationship between the receipt of an involuntary examination in one period and the likelihood of arrests, felony arrests, and misdemeanor arrests in the next period. Involuntary psychiatric examinations were associated with increased risk of arrest. Thus an involuntary examination was a significant signal that individuals with serious mental illness were at risk for criminal behavior and arrest.

Bad Science Makes Bad Law: How Deference Afforded to Psychiatry Undermines Civil Liberties

Courts and lawmakers trust psychiatric expertise when making judicial and public policy decisions concerning mental health, but is this trust well placed? This paper adopts a philosophy of science approach informed by medical research to evaluating the validity of psychiatric classification. This provides the basis for an interdisciplinary critical analysis of civil commitment law and use of psychiatric expert witnesses in light of legal evidence standards. This analysis demonstrates that involuntary civil commitment as it now stands is incompatible with broader due process and civil rights concerns and affords an unjustifiable evidentiary status to psychiatric diagnosis.

Controversy Follows Postponement of New Civil-Commitment Law

In light of limited treatment funds and the resulting delay in implementation of an expanded civil-commitment law, New Jersey psychiatrists will examine whether clinicians at state mental health facilities are fully utilizing the more limited civil-commitment authority that they already have.

Evolving systems of care: Individuals found not criminally responsible on account of mental disorder in custody of civil and forensic psychiatric services

Following psychiatric deinstitutionalization and changes in involuntary civil commitment laws, many individuals with severe mental disorders have been receiving mental health services through the back door, that is, the criminal justice system. Significant changes to the section of Criminal Code of Canada dealing with individuals with mental disorders have led to significant annual increases in the number of individuals declared Not criminally responsible on account of mental disorder (NCRMD), many of whom are directed to civil psychiatric settings. The goal of the present study was to describe the psychosociocriminological and risk characteristics of individuals found NCRMD remanded to civil psychiatric hospitals (CPH) compared to a forensic psychiatric hospital (FPH). This study was conducted between October 2004 and August 2006 in the sole FPH of the province of Québec and two large CPH in the Montréal metropolitan area. The final sample for the current study consisted of 96 men: 60 from the FPH and 36 from the two CPH. Results indicate that individuals in both settings have similar psychosociocriminal profiles, including PCL-R scores, but that individuals in CPH have higher scores in the Risk subscale of the HCR-20 than do their counterparts in the FPH. This difference is due to a higher score on two items: exposure to destabilizing factors and noncompliance with remediation attempts. Results are discussed in terms of the need for civil psychiatric settings to implement risk assessment and management programs into their services, and the need for further research into forensic mental health services.

Sex offender as homo sacer

The political and legal theory of Giorgio Agamben, specifically his concept of homo sacer, can be usefully deployed to understand the regulation and treatment of sex offenders. It is argued that the sex offender can be conceived of as a non-citizen or bare life — the homo sacer — and that this elucidates the degrees of violence and forms of abjection visited upon sex offenders in western societies. Through the institution of laws aimed at protecting communities from sex offenders, specifically community notification and civil commitment laws, there is the production of a ban, whereby the sex offender is displaced into a lawless space — a camp. In this `camp', the sex offender is subjected to GPS electronic monitoring, surgical/chemical castration and various other forms of sovereign violence at the hands of professionals and anti-paedophile vigilante groups. This article shows that in the exertion of sovereign power, where the sex offender is placed in the ambiguous terrain of the camp, there is a restoration of order and maintenance of the sacred.